Abstract No. 189 Short-Term and Long-Term Outcomes of Uterine Artery Embolization for Treatment of Uncontrolled Post-Partum Hemorrhage

To evaluate short-term and long-term outcomes of uterine artery embolization (UAE) for treatment of uncontrolled post-partum hemorrhage (PPH). A retrospective review of patients who underwent UAE for PPH between January 2014 and December 2022 (n=66) was conducted. Baseline demographic and clinical data, time between onset of PPH and UAE, procedural complications, 30-day survival, and post procedural fertility were queried. Data are summarized as median (min-max) or frequency (%) and compared across groups using the Mann-Whitney U test or the Fisher's exact test for numerical or categorical variables, respectively. Median age was 31 years (range: 19-45), and 43/66 (65%) were post-assisted pregnancy. The median time between PPH onset and UAE was 4 hours and 18 minutes (11 minutes–15 days, 23 hours and 49 minutes) with median pre-embolization blood loss of 2760 mL (443-9000). Pre-embolization transfusion was administered in 54/66 (82%) of the subjects. The median duration of embolization was 67 minutes (31-222). Technical success was 100%, and successful hemorrhage control was achieved in 62/66 (94%) of the patients. Better hemorrhage control was achieved in those with lower international normalized ratio (INR) and higher fibrinogen levels prior to embolization (P=0.050 and 0.017, respectively). No death occurred during or after embolization. Four patients with unsuccessful hemorrhage control subsequently underwent total abdominal hysterectomy. Post-embolization syndrome including fever or abdominal pain occurred in 24/66 (36%) of the cases with higher frequency in African American women (P=0.021) and those with higher pre-embolization blood loss (P=0.011). In a median duration of 20 months (0.1-86.3), 5 patients (8%) underwent additional intervention with hysterectomy for hemorrhage control or other reasons, 10 (16%) had successful pregnancy, 4 of which resulted in abortion. Overall infertility rate was 19% with hysterectomy-free infertility rate of 12%, all of which were reported in those with assisted pregnancy prior to embolization (P=0.037). Uterine artery embolization has a high rate of success in controlling post-partum hemorrhage. Better coagulation status including lower INR and higher levels of fibrinogen prior to embolization suggest better hemorrhage control. Assisted pregnancy can suggest the possibility of post-UAE infertility.